New Delhi, Aug 17: Indicating a new but serious fallout of tobacco, scientists at AIIMS report cases in which kids have lost eyesight due to sudden bursting of packets of chuna, an additive used with chewing tobacco, and warn children are at the risk of "irreversibly" damaging their eyes in families where this habit is prevalent.
"In the past year we have seen seven children, aged three-eight years, with severe burning of eye surface leading to visual loss due to bursting of chuna packets," Dr Rasik B Vajpayee from the R P Centre of Opthalmic Sciences, AIIMS, said.

"Three patients are currently admitted at the institute. One child from Rajasthan has lost both his eyes, while a girl has damaged her one eye," Dr Tushar Agarwal from the Centre said. Vajpayee along with Agarwal has published a letter in this respect in the science journal `Lancet'.

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'Chuna' or calcium hydroxide is popularly consumed as an additive in chewing tobacco. Various companies have started marketing the additive in easy to carry pouches which are available for as little as one rupee, Vajpayee said. The pouches are malleable and children view them as toys. When squeezed hard, the calcium hydroxide paste squirts out of the packet. However, if the packet bursts suddenly, chuna is s prayed around and can enter the eyes.

"Once chuna enters the eye, it sticks into the eye under the eyelid. Even thorough washing doesnot remove all the particles," Agarwal said. Chuna particles leach from under the eyelid and get into cornea, destroying its outer covering called epithelium, leading to opaquness, Agarwal said adding initial treatment involves vitamins and topical eye drops, but ulitmately one needs multiple surgeries.

"Many times stem cell transplant is needed to restore the damaged epithelium of the eye but some cosmetic damage and vision loss," he said. Most of the patients treated at AIIMS are from Rajasthan, Madhya Pradesh and Uttar Pradesh.

Experts say that while awareness is low in the country, easy availability of these pouches at low cost, sometimes without even any brand name, makes the problem worse.

"Alkali burn of eye due to bursting of chuna is a possibility. Seven cases in one year is a reasonably big number," Dr Dinesh Talwar from Apollo Hospital said.

Usually cases of burning of eye due to alkali are reported during whitewash and Diwali. Immediate respose to such a situation should be vigorous washing of eye with water till tears composition normalises. However, lack of awareness towards the danger of chuna is a problem.

AIIMS reports one case in which a child was brought almost one year after the injury. Initially, parents approach local doctors, according to Agarwal. Dr K Srinath Reddy involved with WHO's anti-tobacco campaign said that chuna is used frequently. However, any stand could be taken after analysing the extent of damage and number of cases that are being reported.

"We feel that public should be warned about the dangers of these seemingly harmless chuna packets," Vajpayee said. May be these pouches can carry a warning on the possibility of eye damage, Talwar agrees.
Bureau Report